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Question 1
Correct
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Most of the lymph from vessels that drain the breast is collected in which of the following lymph nodes?
Your Answer: Axillary nodes
Explanation:Lymph is the fluid that flows through the lymphatic system. Axillary lymph nodes are near the breasts. They are often the first location to which breast cancer spreads if it moves beyond the breast tissue. They receive approximately 75% of lymph drainage from the breast via lymphatic vessels, laterally and superiorly. The lymph usually first drains to the anterior axillary nodes, and from here, through the central axillary, apical, and supraclavicular nodes in sequence.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 2
Incorrect
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A 52-year-old man develops pneumonia 3 days following an admission for investigation of chest pain. He has coarse left basal crackles and evidence of consolidation in the left lower lobe of chest X-ray. He has no known drug allergies.According to the latest NICE guidelines, which of the following antibacterial agents would be most appropriate to prescribe in this case? Select ONE answer only.
Your Answer: Ciprofloxacin
Correct Answer: Co-amoxiclav
Explanation:Nosocomial infections are defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. They affect 1 in 10 patients admitted to hospital. Annually, this results in 5000 deaths with a cost to the National Health Service of a billion pounds. On average, a patient with hospital acquired infection spent 2.5-times longer in hospital, incurring additional costs of £3000 more than an uninfected patient. Intensive care units (ICU) have the highest prevalence of hospital-acquired infections in the hospital setting.The current recommendations by NICE and the BNF on the treatment of hospital acquired pneumonia are:Early onset infection(less than 5 days after admission to hospital): co-amoxiclav or cefuroxime for 7 daysLate-onset infection(more than 5 days after admission to hospital): an antipseudomonal penicillin (e.g. piperacillin with tazobactam), a broad-spectrum cephalosporin (e.g. ceftazidime), or a quinolone (e.g. ciprofloxacin)If the patient developed a hospital-acquired pneumonia within 5 days of admission – co-amoxiclav would be the most appropriate choice.If the patient has developed a hospital-acquired pneumonia > 5 days after admission – ciprofloxacin would be the most appropriate choice from the list of options available.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 3
Correct
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A 64-year-old lady attends the emergency department with a known brain tumour. Her left eye is directed outwards and downwards, she can't open it, and her pupil is fixed and dilated. The tumour is most likely compressing which of the following structures:
Your Answer: Oculomotor nerve
Explanation:The oculomotor nerve is the third cranial nerve. It is the main source of innervation to the extraocular muscles and also contains parasympathetic fibres which relay in the ciliary ganglion. Damage to the third cranial nerve may cause diplopia, pupil mydriasis, and/or upper eyelid ptosis. The clinical manifestations of third cranial nerve dysfunction reflect its constituent parts.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 4
Correct
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Which of the following is a contraindication for aspirin?
Your Answer: Children under 16 years
Explanation:Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 5
Incorrect
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The patient is a 61-year-old man with severe central chest pain. An acute myocardial infarction is revealed by his ECG. Clopidogrel is one of the medications he takes as part of his treatment.Clopidogrel's direct mechanism of action is which of the following?
Your Answer: Antagonsim of glycoprotein IIb/IIIa receptors
Correct Answer: Inhibition of platelet ADP receptors
Explanation:Clopidogrel, a thienopyridine derivative, prevents platelet aggregation and cross-linking by the protein fibrin by inhibiting the ADP receptor on platelet cell membranes (inhibits binding of ADP to its platelet receptor (P2Y12 ADP-receptor).
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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Question 6
Incorrect
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A patient with a high potassium level is at risk of going into cardiac arrest. What changes in the ECG may indicate the incident of cardiac arrest in this patient?
Your Answer: Prominent U waves
Correct Answer: Peaked T waves and broad QRS complex
Explanation:Severe hyperkalaemia can result in a heart attack or a life-threatening arrhythmia. T waves become narrow-based, pointed, and tall if hyperkalaemia is not treated. The QRS complex widens and eventually merges with the T wave, resulting in a classic sine-wave electrocardiogram. Ventricular fibrillation and asystole are likely to follow.
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This question is part of the following fields:
- Physiology
- Renal
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Question 7
Correct
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The most common complication of paracetamol overdose is:
Your Answer: Hepatic failure
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 8
Incorrect
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Where does angiotensin II directly act on the renal nephron:
Your Answer: Distal convoluted tubule
Correct Answer: Proximal tubule
Explanation:Angiotensin II acts to directly increase Na+reabsorption from the proximal tubule (by activating Na+/H+antiporters).
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This question is part of the following fields:
- Physiology
- Renal
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Question 9
Incorrect
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Which of the following statements about vitamin B12 absorption is TRUE:
Your Answer: Pernicious anaemia results from R protein deficiency.
Correct Answer: On ingestion, vitamin B12 is bound to R protein which protects it from digestion in the stomach.
Explanation:The substance intrinsic factor,essential for absorption of vitamin B12 in the ileum, issecreted by the parietal cells along with the secretion ofhydrochloric acid. When the acid-producing parietalcells of the stomach are destroyed, which frequentlyoccurs in chronic gastritis, the person develops not onlyachlorhydria (lack of stomach acid secretion) but oftenalso pernicious anaemia because of failure of maturationof the red blood cells in the absence of vitamin B12 stimulation of the bone marrow.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 10
Correct
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Many of the chemical digestion and absorption takes place in the small intestine. Most digestive enzymes in the small intestine are secreted by the pancreas and enter the small intestine through the pancreatic duct.Which of these digestive enzymes is responsible for breaking down lipids into fatty acid and glycerol?
Your Answer: Pancreatic lipase
Explanation:The principal enzyme involved in lipid digestion is pancreatic lipase. It breaks down triglycerides into free fatty acids and monoglycerides. Pancreatic lipase works with the help of emulsifying agents secreted by the liver and the gallbladder. The main emulsifying agents are the bile acids, cholic acid and chenodeoxycholic acid. These are conjugated with the amino acids glycine and taurine to form bile salts. Bile salts are more soluble than bile acids and act as detergents to emulsify lipids. The free fatty acids and monoglycerides form tiny particles with these bile salts called micelles. The outer region of the micelle is water-attracting (hydrophilic), whereas the inner core is water-repelling (hydrophobic). This arrangement allows the micelles to enter the aqueous layers surrounding the microvilli and free fatty acids and monoglycerides to diffuse passively into the small intestinal cells.Pancreatic amylase breaks down some carbohydrates (notably starch) into oligosaccharides. Chymotrypsin is a proteolytic enzyme that aids in digestion of proteinCarboxypeptidase hydrolyses the first peptide or amide bond at the carboxyl or C-terminal end of proteins and peptides
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This question is part of the following fields:
- Gastrointestinal Physiology
- Physiology
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Question 11
Correct
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Which of the following is NOT a mineralocorticoid effect of corticosteroids:
Your Answer: Hyperglycaemia
Explanation:Mineralocorticoid side effects include:hypertensionsodium retentionwater retention and oedemapotassium losscalcium lossGlucocorticoid side effects include:weight gainhyperglycaemia and diabetesosteoporosis and osteoporotic fracturesmuscle wasting (proximal myopathy)peptic ulceration and perforationpsychiatric reactions
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This question is part of the following fields:
- Endocrine
- Pharmacology
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Question 12
Incorrect
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By which of the following is mean arterial pressure (MAP) primarily determined?
Your Answer: Central venous pressure and stroke volume
Correct Answer: Total peripheral resistance and cardiac output
Explanation:Mean arterial pressure (MAP) = Cardiac output (CO) x Total peripheral resistance (TPR). Cardiac output is dependent on the central venous pressure (CVP). CVP, in turn, is highly dependent on the blood volume. Any alterations of any of these variables will likely change MAP.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 13
Correct
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A 44-year-old man with an acute episode of gout presents to you and you discuss treatment plan with him.Which one of these statements concerning the treatment of acute gout is true?
Your Answer: A common first-line treatment is Naproxen as a stat dose of 750 mg followed by 250 mg TDS
Explanation:High-dose NSAIDs are the first-line treatment for acute gout. In the absence of any contraindications, Naproxen 750 mg as a stat dose followed by 250 mg TDS is commonly used.Aspirin is contraindicated in gout. It reduces the urinary clearance of urate and also interferes with the action of uricosuric agents. Colchicine is preferred in patients with heart failure or in those who are intolerant of NSAIDs. It is as effective as NSAIDs in relieving acute attacks.Colchicine acts on the neutrophils, binding to tubulin to prevent neutrophil migration into the joint. Where Allopurinol is not tolerated, it has a role in prophylactic treatment of gout.Allopurinol should not be started in the acute phase of gout as it increases the severity and duration of symptoms. It is used as a prophylaxis in preventing future attacks and acts by reducing serum uric acid levels.
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This question is part of the following fields:
- Musculoskeletal Pharmacology
- Pharmacology
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Question 14
Correct
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A 20-year-old male patient lives in a travelling community and has never received any vaccinations. He presents to you with fever.Which of these statements concerning indications and contraindications for vaccination is TRUE?
Your Answer: Inactivated vaccines are safe in pregnancy
Explanation:All vaccines are contraindicated in individuals with: A confirmed anaphylactic reaction to a previous dose of the vaccine or a vaccine containing the same antigens.A confirmed anaphylactic reaction to a component in the vaccine e.g. neomycinThere is no evidence that vaccinating pregnant women with inactivated vaccine or toxoids harms the woman or foetus. The current protocol is that a child with history of egg allergy can be safely vaccinated with Fluenz tetra. However, if they had a previous severe anaphylaxis to egg requiring intensive care, then Flenz tetra is contraindicated. BCG, yellow fever or oral typhoid vaccinations are not safe in HIV positive patients.The normal times recommended for immunization of full-term babies should also be applied to premature infants and correction for gestational age should not be implemented.Concurrent antibiotic therapy is not a contraindication to vaccination.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 15
Correct
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Which segment of the colon is most likely to be affected in diverticulitis?
Your Answer: Sigmoid colon
Explanation:Diverticulitis refers to inflammation and infection associated with a diverticulum and is estimated to occur in 10% to 25% of people with diverticulosis. Peridiverticular and pericolic infection results from a perforation (either macroscopic or microscopic) of a diverticulum, which leads to contamination, inflammation, and infection. The spectrum of disease ranges from mild, uncomplicated diverticulitis that can be treated in the outpatient setting, to free perforation and diffuse peritonitis that requires emergency laparotomy. Most patients present with left sided abdominal pain, with or without fever, and leucocytosis. The most common location for diverticulitis is the sigmoid colon.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 16
Incorrect
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Which of the following statements is incorrect regarding potassium replacement?
Your Answer: Hypokalaemia is frequently associated with chloride depletion and metabolic alkalosis and this should also be corrected.
Correct Answer: Oral potassium supplements are often required for patients taking spironolactone.
Explanation:It is very seldom that potassium supplements are required with the small doses of diuretics given to treat hypertension. Potassium-sparing diuretics like spironolactone (rather than potassium supplements), are recommended for hypokalaemia prevention when diuretics are given to eliminate oedema, such as furosemide or the thiazides.
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This question is part of the following fields:
- Fluids And Electrolytes
- Pharmacology
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Question 17
Correct
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A 66-year-old patient attends the Emergency Department with chest pain. His ECG and troponin are suggestive of a new myocardial infarction. You have explained the condition and the prognosis. He asks you about how the damaged area of his heart will heal following this.Which answer best describes the process of myocardial healing following myocardial infarction? Select ONE answer only.
Your Answer: The damaged myocardium will form non-contractile scar tissue
Explanation:Myocardial cells are unable to regenerate, they are unable to divide in response to tissue injury. The remain permanently in G0 and cannot progress to G1. If a segment of muscle dies, for example in myocardial infarction, this tissue will be replaced by scar tissue if the patient recovers. This scar tissue is non-contractile and therefore the remaining myocardium must work harder to maintain cardiac output. As a consequence the remaining undamaged myocardium undergoes compensatory hypertrophy without cell division.
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This question is part of the following fields:
- General Pathology
- Pathology
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Question 18
Correct
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Regarding bile acids, which of the following statements is INCORRECT:
Your Answer: The main primary bile acids are deoxycholic acid and lithocholic acid.
Explanation:Bile acids have a hydrophobic and a hydrophilic end and in aqueous solution, bile salts orient themselves around droplets of lipid forming micelles to keep the lipid droplets dispersed. The principal primary bile acids are cholic acid and chenodeoxycholic acid. They are made more soluble by conjugation with taurine or glycine in the liver. Of the bile acids excreted into the intestine, about 95% are reabsorbed into the portal circulation by active transport mechanisms in the distal ileum and recycled by the liver.
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This question is part of the following fields:
- Gastrointestinal
- Physiology
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Question 19
Incorrect
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The correct statement regarding the parasympathetic nervous system is which of the following?
Your Answer: Parasympathetic postganglionic neurones release acetylcholine which acts on cholinergic nicotinic receptors.
Correct Answer: Parasympathetic preganglionic neurones run in cranial nerves III, VII, IX and X.
Explanation:The electron transfer system is responsible for most of the energy produced during respiration. The is a system of hydrogen carriers located in the inner mitochondrial membrane. Hydrogen is transferred to the electron transfer system via the NADH2 molecules produced during glycolysis and the Krebs cycle. As a result, a H+ion gradient is generated across the inner membrane which drives ATP synthase. The final hydrogen acceptor is oxygen and the H+ions and O2 combine to form water.
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This question is part of the following fields:
- Basic Cellular
- Physiology
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Question 20
Correct
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A 26 year old male presents to emergency room with a 2 day history of burning pain when passing urine, accompanied by a green urethral discharge. Gonorrhoea is suspected. The first line antibiotic for this condition is which of the following?
Your Answer: Ceftriaxone
Explanation:When there is a high suspicion of gonorrhoea from clinical features, empiric treatment should be commenced whilst waiting for laboratory confirmation. The first line treatment for uncomplicated anogenital and pharyngeal disease includes ceftriaxone 500 mg IM (single dose) + azithromycin 1 g orally as a single dose. This covers concomitant chlamydia infection. For all people who have been treated for gonorrhoea, a test of cure is recommended
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This question is part of the following fields:
- Microbiology
- Pathogens
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Question 21
Correct
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All of the following cause bronchoconstriction, EXCEPT for:
Your Answer: Adrenaline
Explanation:Factors causing bronchoconstriction:Via muscarinic receptorsParasympathetic stimulationStimulation of irritant receptorsInflammatory mediators e.g. histamine, prostaglandins, leukotrienesBeta-blockers
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 22
Correct
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Which of the following statements accurately describes the flexor digitorum superficialis muscle?
Your Answer: It flexes the middle phalanges of the medial four fingers at the proximal interphalangeal joints
Explanation:Flexor digitorum superficialis is the largest muscle of the anterior compartment of the forearm. It belongs to the superficial flexors of the forearm, together with pronator teres, flexor carpi radialis, flexor carpi ulnaris and palmaris longus. Some sources alternatively classify this muscle as an independent middle/intermediate layer of the anterior forearm, found between the superficial and deep groups.Flexor digitorum superficialis is innervated by muscular branches of the median nerve, derived from roots C8 and T1 that arises from the medial and lateral cords of the brachial plexus. The skin that overlies the muscle is supplied by roots C6-8 and T1.The primary arterial blood supply to the flexor digitorum superficialis is derived from the ulnar artery and its anterior recurrent branch. In addition to branches of the ulnar artery, the anterior and lateral surfaces of the muscle are supplied by branches of the radial artery; and its posterior surface also receives branches from the median artery.The main function of flexor digitorum superficialis is flexion of the digits 2-5 at the proximal interphalangeal and metacarpophalangeal joints. Unlike the flexor digitorum profundus, flexor digitorum superficialis has independent muscle slips for all four digits. This allows it to flex the digits individually at their proximal interphalangeal joints. In addition, flexor digitorum superficialis aids the aids flexion of the wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 23
Incorrect
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Needle thoracentesis in a patient with tension pneumothorax is performed at which anatomical landmark?
Your Answer: 2nd intercostal space mid-axillary line
Correct Answer: 2nd intercostal space mid-clavicular line
Explanation:Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration.In determining the correct patient position and site of insertion, it is important for the operator to be aware of the normal anatomy of the thorax and the pathology of the patient. Patient position is dependent on the operator preference and the site of the pathology. In the case of a posterior lying locule, this may be specific to the image-guided spot where fluid is most likely to be obtained. In most circumstances, however, the site of insertion of the needle is either in the triangle of safety or the second intercostal space in the midclavicular line. The patient may therefore either sit upright leaning forward with arms elevated but resting on a table or bed, thereby exposing the axilla, or lying on a bed in a position.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 24
Correct
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A 60-year-old female has a past medical history of diverticular disease. She now presents in the clinic with crampy abdominal pain. The nurse at the triage suggests prescribing hyoscine butyl bromide to help relieve the abdominal pain. However, after administering this treatment, the patient develops a side-effect to the medication. What side-effect of using hyoscine butyl bromide is she MOST likely to develop out of the following?
Your Answer: Dry mouth
Explanation:Hyoscine butylbromide is an antispasmodic drug that blocks muscarinic receptors and reduces intestinal motility. It is used for gastrointestinal and genitourinary smooth muscle spasms and symptomatic relief of IBS.It has the following side-effects:1. Constipation2. Dizziness3. Drowsiness4. Dry mouth5. Dyspepsia6. Flushing7. Headache8. Nausea and vomiting9. Palpitations10. Skin reactions11. Tachycardia12. Urinary disorders13. Disorders of vision
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This question is part of the following fields:
- Gastrointestinal Pharmacology
- Pharmacology
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Question 25
Correct
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A 70-year-old patient develops bacteraemia following peripheral cannulation.Which of these bacteria is the most likely cause of the infection?
Your Answer: Staphylococcus epidermidis
Explanation:The commonest implicated organisms in hospital-acquired bacteraemia following cannulation are Staphylococcus aureus and Staphylococcus epidermidis. The risk is directly proportional to the length of time in-situ. Peripheral cannula should be replaced after 48 hours.
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This question is part of the following fields:
- Microbiology
- Principles Of Microbiology
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Question 26
Incorrect
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Regarding iron handling, which of the following statements is CORRECT:
Your Answer: Most iron in the body is stored in the liver.
Correct Answer: Iron is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1).
Explanation:Dietary iron may be in the form of haem or non-haem iron. Haem iron is degraded after absorption through the cell surface to release Fe2+. Most non-haem iron is in the form Fe3+, which is reduced at the luminal surface to the more soluble Fe2+, facilitated by hydrochloric acid in gastric secretions (and enhanced by ascorbic acid). Fe2+is taken across the enterocyte apical membrane by the divalent metal transporter (DMT1). In the enterocyte, Fe2+is then either stored in enterocyte epithelial cells as ferritin, or released into portal plasma via the molecule ferroportin at the basolateral membrane.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 27
Incorrect
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Gallstones are commonly found lodged in which of the following parts of the gallbladder?
Your Answer: Fundus
Correct Answer: Neck
Explanation:There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 28
Incorrect
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Regarding cytotoxic T cells, which of the following statements is CORRECT:
Your Answer: They secrete cytokines which are required for activation of other immune cells.
Correct Answer: They kill target cells by inducing cell apoptosis.
Explanation:CD8+ T-cells (Cytotoxic T cells)Recognise antigen only in association with HLA Class I molecules (found on all nucleated cells; present endogenous antigens such as those found in cells infected by viruses or intracellular bacteria.)Comprise about 25% of peripheral T-cellsResponsible for cytotoxic killing of target cells
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This question is part of the following fields:
- Immune Responses
- Pathology
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Question 29
Correct
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Which of the following nerves has been damaged when a patient presents with a foot drop?
Your Answer: Common peroneal nerve
Explanation:The common peroneal nerve often referred to as the common fibular nerve, is a major nerve that innervates the lower extremity. It is one of the two major branches off the sciatic nerve and receives fibres from the posterior divisions of L4 through S2 nerve roots. The common peroneal nerve separates from the sciatic nerve in the distal posterior thigh proximal to the popliteal fossa. After branching off of the sciatic nerve, it continues down the thigh, running posteroinferior to the biceps femoris muscle, and crosses laterally to the head of the lateral gastrocnemius muscle through the posterior intermuscular septum. The nerve then curves around the fibular neck before dividing into two branches, the superficial peroneal nerve (SPN) and the deep peroneal nerve (DPN). The common peroneal nerve does not have any motor innervation before dividing; however, it provides sensory innervation to the lateral leg via the lateral sural nerve.The superficial peroneal nerve innervates the lateral compartment of the leg, and the deep peroneal nerve innervates the anterior compartment of the leg and the dorsum of the foot. These two nerves are essential in the eversion of the foot and dorsiflexion of the foot, respectively. The superficial and deep peroneal nerves provide both motor and sensory innervation.The most common presentation with common peroneal nerve injury or palsy is acute foot drop, although symptoms may be progressive and can include sensory loss or pain. Weakness in foot eversion may occur if the superficial peroneal nerve component is involved.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 30
Correct
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A 55-year-old female is urgently rushed into the Emergency Department as she complains of chest pain that is worse on breathing, shortness of breath, palpitations, and haemoptysis. She undergoes a CT pulmonary angiogram, which reveals a large pulmonary embolus. She is immediately started on heparin and shifted to the acute medical ward.Which of the following statements is true regarding heparin?
Your Answer: It activates antithrombin III
Explanation:Heparin is a polymer of glycosaminoglycan. It occurs naturally and is found in mast cells. Clinically, it is used in two forms:1. Unfractionated: widely varying polymer chain lengths2. Low molecular weight: Smaller polymers only Heparin works by binding to and activating the enzyme inhibitor antithrombin III. Antithrombin III inactivates thrombin (factor IIa) by forming a 1:1 complex with thrombin. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. The heparin-ATIII complex can also inactivate IX, XI, XII, and plasmin.Heparin is not thrombolytic or fibrinolytic. It prevents the progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on endogenous thrombolytics.Heparin is used for:1. Prevention and treatment of venous thromboembolism2. Treatment of disseminated intravascular coagulation3. Treatment of fat embolism4. Priming of haemodialysis and cardiopulmonary bypass machinesThere is no evidence that heparin is superior to low-molecular-weight heparins in preventing mortality from thrombosis.Vitamin K is used to reverse the effects of warfarin but not heparin. For heparin, protamine sulphate is used to counteract its effects.
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This question is part of the following fields:
- Cardiovascular Pharmacology
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
